Second City Sessions: Battle of the Titans Continued, Even More Unknown SVT Tracings (On-Demand)-Second City Sessions: Battle of the Titans

Video Transcription

Video Summary

This transcript is a lively Heart Rhythm educational session focused on interpreting electrophysiology tracings through careful measurement and systematic reasoning. Martin Green introduces the faculty and frames the session as collaborative learning rather than a “battle of the titans.”  <br /><br />Eric Prystowski presents several cases showing how subtle interval measurements distinguish AV re-entry from AV node re-entry, and how wide/narrow QRS patterns can be explained by physiology such as Ashman phenomena and long-short sequences. He emphasizes that electrophysiologists must measure components rather than rely only on visual impressions.  <br /><br />Hiroshi Nakagawa discusses accessory pathways, highlighting ECG criteria and pacing maneuvers to identify postero-septal pathways and distinguish AV node conduction from pathway conduction. He shows how premature beats and activation sequence changes can prove an accessory pathway’s participation in tachycardia.  <br /><br />Sabine Ernst presents a difficult redo case in a young patient with prior failed ablations and likely concealed postero-septal pathway conduction. She stresses the importance of anatomy, coronary sinus imaging, and preparing thoroughly with CT/3D imaging before redo procedures.  <br /><br />Martin Green closes with a case suggesting AVNRT with bystander nodal-ventricular pre-excitation, again underscoring stepwise observation and interpretation. The key takeaways are: EP is a team sport, anatomy matters, and careful tracing analysis reveals the story behind the “squiggles.”

Keywords

electrophysiology

AV re-entry

AVNRT

accessory pathway

QRS interval measurement

Ashman phenomenon

pacing maneuvers

postero-septal pathway

redo ablation